PRP: WHERE ARE WE?

JeffreyRapaport,MD,PA

Fellow,AmericanAcademyofDermatologyFellow,AmericanSocietyforDermatologicSurgeryAADPresenta9onHandOuts2.17.2018

SmallVolume/SingleSpin/SimpleSystems

LargeVolume/DoubleSpin/ComplexSystems

VS.

ACPFloa%ngBuoySystems–BuffyCoat

SeparatorGelSystems

Designed for Orthopedics – Higher Platelet Concentration (5x+) – High inflammation – High RBC

and Granulocytes

Emcyte

Magellan

Harvest

Arthrex Angel

Designed for low to medium platelet Concentration (1.4X-4X) Less inflammation - Ideal for Dermatologic Applications

Designed for Orthopedics – Lower Platelet Concentration (2x) – Low inflammation – no

separator gel – easy to mix RBC

Floa%ngBuoySystems–BuffyCoat

Computer-Aided Systems

Patient Indication for PRP Treatment

§  Primary: Androgenic Alopecia (Lower Ludwig or Hamilton preferred)

§  Secondary: Alopecia Areata

§  Traction Alopecia

Scalp Disorders - Partial Effectiveness ?? §  Telogen Effluvium

§  CCCA, Frontal Fibrosing Alopecia, Lichen Planopilaris,

Contraindications: Other §  Pregnancy or breast feeding, cancer or chemotherapy, keloid

development, platelet count less than 105, local infection, hematologic/coagulation disorders, history of untreated thyroid disorders, untreated anemia, severe scalp psoriasis, history of untreated Vitamin D deficiency, body dysmorphic disorder, untreated Hyperandrogenism Syndromes

§  SKIN (S): Thick, with many close-set hair follicles and their associated sebaceous and sweat glands. Firmly joined to next deeper layer

§  SUBCUTANEOUS TISSUE (C), SUPERFICIAL FASCIA: Thick; strong with fiber bundles woven together, with fat interspaced §  Contains superficial vessels and nerves §  Hair follicles of skin project into this layer

§  MUSCULOAPONEUROTIC (A): Represents the deep fascia §  In forehead and occipital regions the frontalis and occipitalis muscles are located here. In temporal region,

auricular muscles are also in this layer §  Galea aponeurotica, a dense, thin, fibrous sheet that unites the frontal and occipital muscles of cranial vault

§  SUBAPONEUROTIC LAYER (L): Very loose and scanty. Contains a few small vessels. The nature of this layer permits easy movement of layers A-C, which act as a unit, over the next layer

§  PERICRANIUM (P): The periosteum of the bones. Except at sutures, is poorly fixed to bone

§  Numb patient’s scalp with a topical

numbing agent (optional)

§  Have patient sign two labels (One label

per tube)

§  Draw blood into appropriate size tube

(usually 22 mL)

§  PRP can be concentrated for better

outcomes

§  Centrifuge at for 3500 RPM for 10 minutes

(See centrifuge instructions)

§  Draw up platelet poor plasma (PPP) using

10 cc syringe and Rigid Needle, leave

platelet rich plasma (PRP)

§  Invert the tube 10-20 times and collect PRP

into syringe §  Optional Add .1 mL lidocaine

§  Change needle to 27 or 30 x ½” gauge

§  Lie patient down

§  Remove topical anesthetic (optional) §  Thoroughly rinse the scalp until no

numbing cream is left

§  Sanitize the scalp with alcohol. The hair

should be easily manipulated with a

comb.

§  Use 27 or 30 gauge x ½ inch needle and

3cc Syringe

§ Start Chiller or

§ 50% O2/50% N2O Analgesia

§ Have patient identify name and signature

§ Subdermal depo injection technique

§ Inject approximately .2 - .5 mL PRP distributed evenly in areas of hair loss

§ Schedule 3-4 monthly treatments followed by a 3-6 month maintenance interval

*For use with standard PRP. Not effective with activated PRP.

§  Mounting body of evidence FOR effectiveness of PRP for Hair Restoration

§  Increased critical scientific data needed

§  Standardization in PRP protocols including preparation, composition and activation

§  More human studies with quantitative analysis, control groups, blinding, longer time frames, single variables, larger sample sizes, standardized outcome assessment (allowing meta-analysis)